Q: I am 43 year old woman suffering from pain in my knee joints and also feel some heaviness in my feet. I have already used several pain killers such as diclofenac sodium but did not get any relief. I do not suffer from high blood pressure or diabetes. Please suggest the treatment if my problem is curable.

A:The most likely cause in your case can be early osteoarthritis, though less common for your age and weight. Osteoarthritis is a progressive disease and there is no curative medicine in such cases. However, there are medications which can help to decrease your pain. Basically the knee joint is composed of 3 bones: thigh bone-(femur), leg bone-(tibia) and knee cap-(patella). All these bones have cushion like cartilage at their end. The wearing of this cartilage gives a chance to the bones to rub on each other and cause pain. This is called osteoarthritis. I suggest the following things:

1. When you wake up in the morning, don't just start walking. While in the bed, bend and extend your knees for sometime. This will allow the joint fluid to redistribute in the knee.
   
2. Don't sit on the floor or in a squatting position. It is common in Asian communities to sit on the floor or squat while praying, preparing meals or in the toilet. Use a high chair for your daily activities.
   
3. Diclofenac in long run can cause side effects, gastric upset being the commonest. I suggest taking Celecoxib (available in India as Zycel) 200 mg once in the evening or Rofecoxib 12.5 mg in the morning. These drugs provide good pain relief without significant side effects.
   
4. Use analgesic gel (voveran gel) and massage it lightly over the knees 2 to 3 times a day. dont massage it with pressure, just apply lightly.
   
5. To improve the kinematics of your knees, you need to strenthen your muscles around the knee joint. your exercises should include quadriceps drill, hamstring strenthining exercises and foot dorsiflexion/palmar flexion stretching. (go to the physical therapist once to learn these exercises and then you can do them at home). Swimming is the best exercise and climbing stairs should be discouraged.
   
6. You can use heat in any form ( hot water bags, electric bags) over your knees while going to bed.
   
7. Avoid walking long distances.

I think modifying your lifestyle a bit will help you a lot. There are many other medications (steroids for example) which can be used, but i think you are too young for those drugs. There are also other modalities of treatment like bracing, injections in the joints etc, but i dont recommend it for early disease.